Journal of Emergency Medicine最新文献

{"title":"Rescue Sedation after 5 mg or 10 mg of Droperidol as the Initial Treatment for Acute Agitation in the Emergency Department","authors":"Jon B. Cole MD ,&nbsp;Kathryn A. Glass PharmD ,&nbsp;Quin T. Stevens MD ,&nbsp;Amber R. LeBrun PharmD ,&nbsp;Nicholas A. Beaupre PharmD ,&nbsp;Brian E. Driver MD","doi":"10.1016/j.jemermed.2024.07.005","DOIUrl":"10.1016/j.jemermed.2024.07.005","url":null,"abstract":"<div><h3>Background</h3><div>Droperidol is used commonly to treat agitation in the emergency department (ED), however, data comparing doses are lacking.</div></div><div><h3>Objective</h3><div>The aim of this study was to compare the effectiveness of 5 mg vs. 10 mg as initial droperidol dose for acute agitation in the ED.</div></div><div><h3>Methods</h3><div>This single-center, retrospective study examined adult ED patients receiving either 5 mg or 10 mg droperidol as the first agent to treat agitation from 2010 to 2023. The primary outcome was need for additional (rescue) sedation within 1 h of initial droperidol dose.</div></div><div><h3>Results</h3><div>The authors identified 11,568 patients who received droperidol as their first medication (n = 8603 [74%] via intramuscular route); 10,293 received 5 mg and 1275 received 10 mg. Median age was 39 years (interquartile range 28–50 years); 8372 (72%) were male. Rescue sedation within 1 h was administered to 987 patients (9.6%) in the 5-mg group and 189 patients (14.8%) in the 10-mg group (difference 5.2%; 95% CI 3.2–7.3%). Additional sedation at any time was administered to 1776 patients (17.3%) in the 5-mg group and 318 (24.9%) in the 10-mg group (difference 7.7%; 95% CI 5.2–10.2%). Median length of stay was 471 min (interquartile range 347–611 min) in the 5 mg group and 487 min (interquartile range 364–641 min) in the 10-mg group (median difference 24 min; 95% CI 11–37 min).</div></div><div><h3>Conclusions</h3><div>In this large cohort, patients deemed appropriately treated with 5 mg of droperidol required less rescue sedation than patients determined to need 10 mg.</div></div>","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"68 ","pages":"Pages 73-83"},"PeriodicalIF":1.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142791987","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Characteristics of High Utilizer Patients in the Emergency Department at a University Hospital in the Kingdom of Bahrain","authors":"Naser Aljawder MD ,&nbsp;Israa Sinan BSc ,&nbsp;Faisal Qureshi MD ,&nbsp;Eyad Bucheer MD ,&nbsp;Aysha Aljawder MD","doi":"10.1016/j.jemermed.2024.07.003","DOIUrl":"10.1016/j.jemermed.2024.07.003","url":null,"abstract":"<div><h3>Background</h3><div>Emergency departments (EDs) around the world are facing a crippling crisis of overcrowding, a complex problem caused by a variety of factors. One contributing factor is the overutilization of EDs by patients with frequent visits.</div></div><div><h3>Objective</h3><div>This study aims at measuring the prevalence of this phenomenon and better understanding the characteristics of high utilizers.</div></div><div><h3>Methods</h3><div>A retrospective review was conducted in a tertiary care teaching hospital, for patients aged 14 years and above during the year 2022. The definition of a high utilizer is set as any patient that fits the inclusion criteria with four or more visits to the ED during 1 year.</div></div><div><h3>Results</h3><div>The prevalence of high utilizers in our ED is 3.9%, accounting for 12.1% of visits in 2022, where 135 was the highest number of visits made by one patient. Visits mostly consisted of level 3, Yellow (48.9%) and level 4, Green (42.8%) triage. The top three chief complaints were sore throat (16.8%), unwell adult (15.1%), and abdominal pain (12.8%). The total length of stay was 3.6 ± 3.2 h in the ED. Time of arrival was observed; 23.9% presented at night, 37.8% in the morning, and 38.8% in the evening.</div></div><div><h3>Conclusions</h3><div>The prevalence rate of high utilizers was found to be 3.9% in our study, falling within the range based on literature. Due to the parallel issues raised by many studies, the importance of developing convenient corrective strategies and conducting further national-based studies to get better insight of high utilizers is required.</div></div>","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"68 ","pages":"Pages 100-108"},"PeriodicalIF":1.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143006703","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Integrating Longitudinal Simulation-Based Education: Enhancing Trainee Competence in U.S. Emergency Medicine Residency Programs","authors":"Sara Hock MD ,&nbsp;Afrah A. Ali MBBS ,&nbsp;Kimberly Sokol MD, MS, MACM ,&nbsp;Jerome Balbin MD ,&nbsp;Suzanne K. Bentley MD, MPH ,&nbsp;Vivienne Ng MD, MPH","doi":"10.1016/j.jemermed.2024.07.001","DOIUrl":"10.1016/j.jemermed.2024.07.001","url":null,"abstract":"","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"68 ","pages":"Pages 96-99"},"PeriodicalIF":1.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143006713","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Review of Pediatric Appendicitis Imaging Trends from 2006–2020 Using the Nationwide Emergency Department Sample","authors":"Bradley End MD ,&nbsp;Kimberly Quedado PhD ,&nbsp;Garrick Anderson MD ,&nbsp;Syed Kazmi MD ,&nbsp;Hansol Chung MD ,&nbsp;Jessica Neidhardt MD ,&nbsp;Courtney Cundiff MD ,&nbsp;Wei Fang PhD ,&nbsp;Joseph Minardi MD","doi":"10.1016/j.jemermed.2024.07.012","DOIUrl":"10.1016/j.jemermed.2024.07.012","url":null,"abstract":"<div><h3>Background</h3><div>Appendicitis is a common surgical emergency in the pediatric population, affecting over 70,000 children per year in the United States alone. While historically practitioners predominately used computed tomography (CT) as the main diagnostic imaging modality, multiple professional societies have released guidelines recommending an ultrasound (US) first strategy when using imaging to confirm suspected appendicitis in pediatric populations. To date, no studies have quantified the change in imaging trends for pediatric appendicitis across the spectrum of healthcare facilities in the United States utilizing the Nationwide Emergency Department Sample (NEDS).</div></div><div><h3>Objectives</h3><div>We aimed to evaluate the imaging trends for pediatric appendicitis across the nation, stratified by age and gender. Specifically, we wanted to delineate the use of CT alone versus US alone or US first imaging strategies.</div></div><div><h3>Methods</h3><div>This retrospective cross-sectional study utilized data from the NEDS spanning from 2006 through 2020. We examined and analyzed the total number of patients, the number of patients with available imaging data, sex, age, and included imaging modalities utilizing descriptive statistics and regression analyses. Similarly, regression analysis was employed to discern differences in imaging rates in time intervals following societal imaging recommendations.</div></div><div><h3>Results</h3><div>From 2006 to 2020 the database recorded 160,828 encounters for pediatric appendicitis. Imaging data was available for 101,248 encounters, accounting for 63% of the total sample. Over the study period, both rates of “US only” and “US first” imaging modalities increased (from 5.5% to 38.9% and 8.9% to 55.6%, respectively), while rates of CT utilization in isolation declined (from 91.1% to 44%).</div></div><div><h3>Conclusion</h3><div>While there is an increasing trend towards US being used as the first imaging modality to diagnose pediatric appendicitis across the spectrum of facilities included in the NEDS, continued utilization of CT to diagnose appendicitis remains unacceptably high in the pediatric population within the limits of this retrospective study.</div></div>","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"68 ","pages":"Pages 25-33"},"PeriodicalIF":1.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142854400","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Woman with Shortness of Breath","authors":"William Bleifuss MD,&nbsp;Brian Mehus MD","doi":"10.1016/j.jemermed.2024.08.007","DOIUrl":"10.1016/j.jemermed.2024.08.007","url":null,"abstract":"","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"68 ","pages":"Pages 93-95"},"PeriodicalIF":1.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142983700","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Visual Diagnosis in Emergency Medicine: A Shock to the System: The Uncommon Encounter of a Transcranial TASER Injury","authors":"Ritika Gudhe MD,&nbsp;Batsheva Sholomson DO,&nbsp;Adil Husain MD,&nbsp;Abbas Husain MD,&nbsp;Barry Hahn MD","doi":"10.1016/j.jemermed.2024.07.013","DOIUrl":"10.1016/j.jemermed.2024.07.013","url":null,"abstract":"","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"68 ","pages":"Pages 89-92"},"PeriodicalIF":1.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142983771","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Distinguishing Peripheral from Central Causes of Dizziness and Vertigo without using HINTS or STANDING","authors":"Jonathan A. Edlow MD, FACEP","doi":"10.1016/j.jemermed.2024.06.009","DOIUrl":"10.1016/j.jemermed.2024.06.009","url":null,"abstract":"<div><div>Three validated diagnostic algorithms for diagnosing patients with acute onset dizziness or vertigo (HINTS, HINTS-plus and STANDING) exist. All are extremely accurate in distinguishing peripheral from central causes of dizziness when done by experienced clinicians. However, uptake of these diagnostic tools in routine emergency medicine practice has been sub-optimal, in part, due to clinicians’ unease with the head impulse test, the most useful component contained of these algorithms. Use of these validated algorithms is the best way to accurately diagnose patients with acute dizziness. For clinicians who are unfamiliar with or uncomfortable performing or interpreting HINTS and STANDING, this article will suggest alternative approaches to help with accurate diagnosis of patients with acute dizziness or vertigo.</div></div>","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"67 6","pages":"Pages e622-e633"},"PeriodicalIF":1.2,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141707458","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Increased Human Chorionic Gonadotropin Level in a Nonsexually Active Young Female","authors":"Natalie Mira Elder MD, PharmD,&nbsp;Ashley McCormick DO","doi":"10.1016/j.jemermed.2024.07.020","DOIUrl":"10.1016/j.jemermed.2024.07.020","url":null,"abstract":"<div><h3>Background</h3><div>Quantitative and qualitative human chorionic gonadotropin (hCG) tests are obtained in the emergency department (ED) to determine if a female of child-bearing age is pregnant. A positive hCG result is commonly assumed to indicate an intrauterine or other form of pregnancy. However, elevated hCG levels can also result from various other conditions, such as ovarian tumors, pituitary tumors, and thyroid disorders. Intracranial germ cell tumors, rare central nervous system tumors capable of secreting hCG, primarily affect adolescent and young adult females.</div></div><div><h3>Case Report</h3><div>A 16-year-old female student without significant past medical history presented to our ED with a complaint of intermittent bilateral frontal headache for two days. Last menstrual period started two days prior to presentation. The headache was associated with phonophobia, photophobia, nausea, and vomiting. Serum quantitative hCG was elevated. She denied history of sexual activity or sexual assault. Transabdominal ultrasound was negative for intrauterine pregnancy. Obstetrics and gynecology as well as pediatric oncology were consulted. Subsequent investigations, including brain imaging, revealed a 3.5 cm mass in the right caudate nucleus and corpus callosum. The patient was diagnosed with an intracranial nongerminomatous germ cell tumor, necessitating hospitalization and prompt initiation of chemotherapy.</div></div><div><h3>Why Should an Emergency Physician Be Aware of This?</h3><div>An elevated quantitative hCG is not always indicative of pregnancy, especially in a young patient without sexual history. In the case of a nonrevealing transabdominal ultrasound, obstetrics and gynecology should be consulted for discussion of further testing and imaging. Emergency physicians should include malignancy high on their differential since prompt initiation of chemotherapy, evaluation by surgical services, and family planning will be required.</div></div>","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"67 6","pages":"Pages e569-e571"},"PeriodicalIF":1.2,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142145772","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Anoxic Brain Injury: A Subtle and Often Overlooked Finding in Non-Fatal Intimate Partner Strangulation","authors":"Sean Dugan MD, FAAP ,&nbsp;Michelle Patch PhD, APRN-CNS, DF-AFN, FAAN ,&nbsp;Taman Hoang MD, MS ,&nbsp;Jocelyn C. Anderson PhD, RN, SANE-A","doi":"10.1016/j.jemermed.2024.06.006","DOIUrl":"10.1016/j.jemermed.2024.06.006","url":null,"abstract":"<div><h3>Background</h3><div>A paucity of literature exists dedicated to the identification of anoxic brain injury in patients that survive non-fatal intimate partner strangulation (NF-IPS). While some individuals report experiencing symptoms of brain hypoxia followed by a loss of consciousness, other individuals report symptoms of brain hypoxia prior to amnesia, rendering some unable to recall loss of consciousness (LOC).</div></div><div><h3>Objective</h3><div>Using a standardized clinical assessment tool, the purpose of this retrospective analysis is to describe anoxic brain injury symptom prevalence in a sample of patients reporting NF-IPS.</div></div><div><h3>Methods</h3><div>One hundred and ninety-one unique patients, reporting a total of 267 strangulation events, were assessed by a member of the Shasta Community Forensic Care Team utilizing the Strangulation Hypoxia Anoxia Symptom TBI Assessment (SHASTA) tool. The sample is 98% female and includes adult patients ages 18–68. Examination records were categorized based on the presence or absence of hypoxia and anoxia symptoms. This manuscript utilizes the STROBE checklist.</div></div><div><h3>Results</h3><div>Amnesia was reported in 145 of the 267 strangulations (54.3%). Of those, 74 reported LOC (51.0%) while 71 did not recall LOC (49.0%).</div></div><div><h3>Conclusions</h3><div>Within our sample, 49% of patients with amnesia did not recall losing consciousness, demonstrating that LOC is an imperfect measure of anoxia for patients following NF-IPS. Healthcare providers examining NF-IPS patients should inquire about additional symptoms of hypoxia and amnesia, which can be captured on the SHASTA tool.</div></div>","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"67 6","pages":"Pages e599-e607"},"PeriodicalIF":1.2,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142289280","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Role of Language in Hospital Admissions: The COVID-19 Experience in a Safety-Net Hospital Emergency Department","authors":"Emily Bacon PhD ,&nbsp;Molly E. Thiessen MD ,&nbsp;Jody Vogel MD, MSc ,&nbsp;Jennifer Whitfield MD, MPH ,&nbsp;Lilia Cervantes MD ,&nbsp;Laura Jean Podewils MS, PhD","doi":"10.1016/j.jemermed.2024.06.004","DOIUrl":"10.1016/j.jemermed.2024.06.004","url":null,"abstract":"<div><h3>Background</h3><div>Emergency departments (EDs) are often patients’ first point of contact with the health care system. Race, ethnicity, and language all influence factors leading up to ED visits and patient experiences within the ED. There is limited evidence showing how race, ethnicity, and language interact to shape ED experiences, particularly during the COVID-19 pandemic when EDs were extremely strained.</div></div><div><h3>Objectives</h3><div>Using a retrospective review, we evaluated the association of race, ethnicity and preferred language on hospital admissions from the ED for patients with COVID-19 in an urban, safety-net hospital during the first year of the COVID-19 pandemic before vaccines were widely available.</div></div><div><h3>Methods</h3><div>We performed a nested regression analysis using generalized estimating equation (GEE) logit models to estimate the impact of language, race, and ethnicity on hospital admissions while controlling for other health conditions and healthcare utilization.</div></div><div><h3>Results</h3><div>Patients who spoke Spanish and were Latino had 72% higher odds [95% confidence interval (CI):1.34–2.2] of hospital admission compared to patients who were White and spoke English. Patients who were Asian, the majority of whom also spoke languages other than English, had 130% higher odds (95% CI: 1.39–3.92) of hospital admission compared to patients who were White and English Speaking.</div></div><div><h3>Conclusions</h3><div>Findings suggest multiple mechanisms influence hospital admissions for patients who are racially and ethnically minoritized and speak Spanish. Providers may have admitted patients as a precaution rather than because of more advanced illness. Evaluating race, ethnicity, and language concurrently can reveal how intersectional factors shape patient experiences in the ED.</div></div>","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"67 6","pages":"Pages e578-e589"},"PeriodicalIF":1.2,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141404205","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}